Olecranon fracture

Background

• Occurs via direct trauma or by fall with forced hyperextension of elbow
• Common in high energy mechanism in young and falls in elderly
• Associated injuries are common:
  • Dislocations, radial head fracture, ulnar nerve injury

Clinical Features

• Pain, swelling, and occasionally over posterior elbow
• Forearm extension strength is reduced (triceps inserts at the olecranon)

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Septic bursitis
• Biceps tendon rupture/dislocation

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Imaging

• AP lateral, requires true lateral
• Radiocapitellar view helps visualize radial head fracture, capitellar shear fracture
• CT can assist with operative planning

Management

• Rule-out ulnar nerve injury
• Immobilize with long arm posterior mold with elbow in flexion and forearm neutral
• Refer to ortho within 24hr
• Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks

See Also

• Elbow diagnoses
• Elbow Fractures (Main)

References

• Orthobullets

Authors

Ross Donaldson, Jonathan Snyder, Michael O'Brien, MD, Neil Young, Daniel Ostermayer, Claire